LARC Study: More Consistent Use, Lower Pregnancy Rate

Advantages of long-acting reversible contraception affirmed

Women randomized to long-acting reversible contraception methods were more likely to still be using this method after a year compared to short-acting contraception, such as the pill or a hormonal injection, researchers said.

In a partially randomized trial, women were given the choice as to whether they wanted to be randomized to a particular contraception method (short-acting or long-acting) or if they had a preferred method. Of the women who were randomized, LARC users were significantly more likely to continue with it, and showed a significantly lower rate of unintended pregnancy, compared with women randomized to short-acting methods, reported David Hubacher, PhD, of FHI 360, a non-profit organization in Durham, N.C., and colleagues.

Hubacher and colleagues found a 12 month continuation probability of 77.8% for LARC users and 53.0% for short-acting contraception users (P<0.001).

The overall rate of unintended pregnancy was 0.7% in the long-acting group versus 6.7% in the short-acting group (P=0.01). Not surprisingly, rates of unintended pregnancy were also higher among the group of women who did not elect to be randomized, and opted for short-acting contraception (5.5%), according to the researchers' report in the American Journal of Obstetrics and Gynecology.

"This study clearly demonstrates that it is the methods (IUDs and implants), and not the type of women who prefer them, that cause low pregnancy rates," commented David Turok, MD, of University of Utah in Salt Lake City, who was not involved with the study, in a statement issued by the journal's publisher.

The uptake of long-acting reversible contraception is still relatively low among U.S. women, despite recent recommendations from the American College of Obstetricians and Gynecologists to offer long-acting reversible contraception to pregnant women immediately following delivery. The American of Pediatrics has also recommended LARC as a "first-line" method of contraception for adolescents.

Hubacher explained in the journal's statement that the high level of unintended pregnancies (over 40% of all pregnancies) has not changed since the 1990s.

"An increase in voluntary uptake of LARC could help avert many unintended pregnancies, thus reducing associated health risks and other negative consequences," he said. "Our research found scientific evidence that typical users of short-acting reversible contraception can find LARC highly acceptable."

Researchers recruited 896 women at a Planned Parenthood clinic (where women would generally go to get short-acting contraception) and gave them the choice of randomization or preferred method of contraception. Overall, 57% chose their preferred method, while 43% opted to be randomized. Short-acting contraception included oral contraceptives or a depot medroxyprogesterone acetate injection, while long-term contraception consisted of an IUD or a subdermal implant.

A significantly greater portion of women in the randomized groups did not have health insurance versus those with a preference for short-acting contraception. As might be expected, a significantly smaller portion of long-acting contraception users "desired a future child."

While more than three-quarters of women randomized to long-acting reversible contraception described themselves as "happy" or "neutral" with their contraceptive method of choice, women who were randomized to or chose short-acting contraception were even more likely to express satisfaction with that method.

"It certainly bears acknowledging that not all women want LARC and it is clear that not all women will be satisfied with LARC," said Hubacher.

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